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38 Cards in this Set

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Where do atrial (supraventricular) arrythmias occur?

Above the level of the ventricles. Outside the sinus node but above the branching portion of the Bundle of His

What electrophysiologic mechanism is responsible for atrial arrhythmias?


1. _______________


2. _______________


3. _______________

1. Increased automaticity


2. Re-entry


3. Triggered activity

What causes electrophysiologic mechanism dysfunctions?


1. _______________


2. _______________


3. _______________


4. _______________


5. _______________


6. _______________

1. MI


2. Electrolyte imbalances


3. Increased sympathetic tone (catecholamines


4. Stretch of chambers


5. Digoxin toxicity


6. Pro-arrhythmic effects of antiarrhythmic drugs

What may cause the QRS to be wide? (>0.10 seconds)


1 _______________


2 _______________

1. If there is an underlying Bundle Branch Block (BBB)


2. If beats are aberrantly conducted (one of the bundle branches has not repolarized and is unable to conduct normally)

Enhanced automaticity

- firing rate of latent pacemaker cells is increased beyond their inherent rate


- cell membrane becomes permeable to Na during Phase 4 --> leakage of Na into cell and sharp rise in Phase 4


- nonpacemaker cells can acquire enhanced automaticity under certain conditions and depolarize spontaneously

What can enhanced automaticity cause?

atrial, junctional, and ventricular ectopic beats and rhythms

Common causes of enhanced automaticity


1. _______________


2. _______________


3. _______________


4. _______________


5. _______________


6. _______________


7. _______________


8. _______________


9. _______________


10._______________

1. increase in sympathetic tone


2. digitalis toxicity


3. hypoxia


4. hypercapnia


5. myocardial ischemia or infarction


6. stretching of the heart


7. hypokalemia


8. hypocalcemia


9. heating or cooling of the heart


10. certain drugs



What is re-entry

The condition in which the progression of an electrical impulse is delayed or blocked (or both) in one or more sections of the conduction system, while the electrical impulse is conducted normally through the rest of the conduction system




= delayed impulse entering cardiac cells which have just been depolarized by the normally conducted impulse = ectopic beats

Re-entry can result in ...

abnormal generation of a single or repetitive electrical impulse in the SA node, atria, AV junction, bundle branches, and Purkinje system

Most common causes of re-entry


1. _______________


2. _______________

1. Ischemia


2. Hyperkalemia

What is triggered activity

an abnormal condition of the latent pacemaker and non pacemaker cells in which these myocardial cells can depolarize more than one following stimulation by a single electrical impulse

Triggered activity can occur during ...

Immediately following depolarization (early after depolarization) or late in Phase 4 (delayed after-depolarization)

Triggered activity can result in

Atrial or ventricular ectopic beats occurring singly, in pairs, or in burst of three or more beats

Common causes of triggered activity


1. _______________


2. _______________


3. _______________


4. _______________


5. _______________

1. Increase in catecholamines


2. Digitalis toxicity


3. Hypoxia


4. Myocardial ischemia


5. Injury and stretching or cooling of the heart

What are premature atrial contractions?

Extra atrial contractions originating from a focus other than the sinus node that occur before the next expected P wave


- the timing is "reset" resulting in an incomplete compensatory pause

Premature atrial contractions clues


1. _______________


2. _______________


3. _______________


4. _______________


5. _______________

1. Early P waves that vary in shape and may be buried in T wave before


2. R-R interval varies


3. Rhythm irregular (incomplete pause)


4. QRS is usually normal but may be wide


5. "P" may be non-conducted resulting in no QRS following

Premature atrial contraction possible causes


1. _______________


2. _______________


3. _______________


4. _______________


5. _______________

1. Overstretching of atria: volume overload, heart failure, valvular heart disease


2. Increased sympathetic tone


3. Stimulants


4. Electrolyte imbalance


5. Dig toxicity



Premature atrial contractions hemodynamic effects

Asymptomatic but maybe a warning sign of more serious arrhythmias

Premature atrial contraction treatments

Correct underlying cause

What is atrial tachycardia/SVT

occurs when an ectopic focus in the atria takes over the sinus node



What is the atrial rate in SVT

150-250 bpm

SVT clues


1. _______________


2. _______________


3. _______________


4. _______________


5. _______________

1. P waves 150-250 that may be difficult to see


2. Ventricular QRS rate may be same as the atrial rate of the AV node may block (often 2:1)


3. QRS normal but may be wide


4. Rhythm regular


5. Sudden stop/start

SVT possible causes


1. _______________


2. _______________


3. _______________


4. _______________


5. _______________


6. _______________

1. Overstretching of the atria


2. Incresed sympathetic tone


3. Accessory pathways (WPW, AV node re-entry)


4. Stimulants


5. Electrolyte imbalance


6. Digoxin toxicity

SVT hemodynamic effects


1. _______________


2. _______________


3. _______________


4. _______________


5. _______________


6. _______________

1. May be asymptomatic


2. Symptomatic as rates increase


3. There is no time for ventricles to fill in diastole


4. Symptomatic: loss of "atrial kick", decrease SV/CO, decreased BP, increased workload of the heart, feelings of palpitations/increased anxiety


5. Increased ischemia


6. Increased chest pain

SVT treatments


1. _______________


2. _______________


3. _______________


4. _______________


5. _______________


6. _______________


7. _______________


8. _______________


9. _______________

1. Correct underlying cause


2. Vagal maneuvers


3. Adenosine


4. Calcium channel blockers


5. Beta blockers


6. Amiodarone


7. Procainamide


8. Cardioversion


9. Ablation

Which SVT treatments treat symptoms


1. _______________


2. _______________


3. _______________


4. _______________


5. _______________


6. _______________

1. Vagal maneuvers


2. Adenosine


3. Calcium channel blockers


4. Beta blockers


5. Amiodarone


6. Procainamide

Which SVT treatment needs conscious sedation

Cardioversion

What is ablation

burns extra pathway

What is atrial flutter

A rapid (240-400) ectopic focus in the atria characterized by flutter waves of a "saw tooth" and usually a slower ventricular response as the AV node blocks some of the impulses

Atrial flutter clues


1. ________________


2. ________________


3. ________________

1. Saw tooth pattern of flutter waves (average 300 min)


2. Ventricular rate is often 1/2 of atrial


3. Typically regular but may be irregular if conduction through AV node varies

Atrial flutter possible causes


1. ________________


2. ________________


3. ________________


4. ________________


5. ________________


6. ________________


7. ________________

1. Overstretching of atria


2. Increased sympathetic tone


3. Hypertension


4. Pulmonary hypertension


5. Thyrotoxicosis


6. Electrolyte imbalance


7. Dig toxicity

Atrial flutter hemodynamic effects


1. ________________


2. ________________

1. May be asymptomatic


2. Symptomatic as rate increases:


- Loss of "atrial kick"


- Decreased SV


- Decreased CO


- Decreased BP


- Increased workload of heart


- Increased ischemia

Atrial fluter Treatments


1. ________________


2. ________________


3. ________________


4. ________________


5. ________________


6. ________________


7. ________________


8. ________________

1. Correct underlying cause


2. Vagal maneuvers


3. Amiodarone


4. Calcium channel blockers


5. Beta blockers


6. Digoxin


7. Procainamide


8. Cardioversion

What is Atrial fibrillation

results from multiple chaotic ectopic foci in the atria with many electrical impulses "bombarding" in the AV node

Atrial fibrillation clues


1. ________________


2. ________________

1. No P waves, instead a "wavy" (fibrillatory) baseline


2. Irregular ventricular (QRS) rhythm - R-R interval

Atrial fibrillation possible causes


1. ________________


2. ________________


3. ________________


4. ________________


5. ________________


6. ________________


7. ________________



1. Overstretching of atria


2. Increased sympathetic tone


3. Hypertension


4. Pulmonary hypertension


5. Thyroxtoxicosis


6. Electrolyte imbalance


7. Digoxin toxicity



Atrial fibrillation hemodynamic effects


1. ________________


2. ________________

1. May be asymptomatic


2. Symptomatic:


- loss of atrial kick esp as ventricular rate increases


- decreased SV


- decreased CO


- decreased BP


- Increased workload of heart


- Increased ischemia

Atrial fibrillation treatments


1. ________________


2. ________________


3. ________________


4. ________________


5. ________________


6. ________________


7. ________________


8. ________________



1. Correct underlying cause


2. Vagal maneuvers


3. Amiodarone


4. Calcium channel blockers


5. Beta blockers


6. Digoxin


7. Procainamide


8. Cardioversion